BackgroundIsoniazid (INH) is used to treat latent tuberculosis infection (LTBI), and hepatotoxicity is one of the most frequent adverse effect. Several Disease-modifying drugs (DMARDs) can also cause hepatotoxicity. Many patients with rheumatic immune mediated diseases (R-IMID) receive INH prior to DMARDs for prophylaxis of LTBI. This risk of hepatotoxicity with DMARDs after hepatotoxicity with INH is unknown.ObjectivesTo assess the risk of hepatotoxicity with DMARDs in patients who have presented hepatotoxicity with INH.MethodsStudy of all consecutive R-IMID patients evaluated in the last five years (2016-2020) in a University Hospital, who presented hepatotoxicity after INH and later received DMARDs. We study if they also presented hepatotoxicity with DMARDs.Hepatotoxicity was defined as an elevation of liver enzymes (ALT and/or AST) upper the high limit after the introduction of the treatment.ResultsINH was used in 232 of 7218 patients with R-IMID. We finally included 64 patients (45 women; 70.3%; mean age 53.4±10.5 years), who had hepatotoxicity due to INH (Table 1).Table 1.Main characteristics of 64 patients with rheumatic immune-mediated diseases (R-IMID) that presented hepatotoxicity after receiving isoniazid (INH).VariablesPatients (n=64)Age (years), mean ±SD53.4±10.5Sex (women), n (%)45 (70.3)R-IMID- SpA / PsA36 (56.3%)- RA21 (32.8%)- SSc3 (4.7%)- Conectivopathies3 (4.7%)- Other2 (3.2%)Liver enzyme elevation over baseline (INH)*- x264 (100)- x322 (34.4)- x4 or higher13 (20.3)csDMARDs- MTX34 (53.1%)- HCQ15 (23.4)- LFN13 (20.3)- SSZ10 (15.6)bDMARDs47 (73.4%)Targeted synthetic DMARDs (Jakinib)8 (12.5)ABA: Abatacept; AZA: Azathioprine, HCQ: Hydroxychloroquine; INH: Isoniazid; LFN: Leflunomide; MMF: Mycophenolate mofetil, MTX: Methotrexate; PsA: Psoriatic arthritis, RA: Rheumatoid arthritis, RTX: Rituximab; SpA: Axial spondyloarthritis; SSc: Systemic sclerosis; TCZ: Tocilizumab; TNFi: TNF inhibitors* Patients with higher liver enzyme elevation are included in the previous groups.The most frequent R-IMIDs were rheumatoid arthritis, axial spondyloarthritis and psoriatic arthritis. Methotrexate (MTX) (n=34, 53.1%) and TNF inhibitors (n=27, 42.2%) were the conventional and biologic-DMARD more frequently used, respectively.Hepatotoxicity was higher with MTX (14 of 34, 41.2%), and lower with the other DMARDs (Figure 1). Hepatotoxicity was not observed with hydroxychloroquine, azathioprine, mycophenolate mofetil, secukinumab, abatacept or rituximab.Figure 1.Hepatotoxicity with different DMARDs in 64 patients with previous hepatotoxicity with INH* Patients with higher liver enzyme elevation are included in the previous groups.ConclusionIn patients with previous hepatotoxicity with INH, we observed an increased risk with different DMARDs, especially with MTX.Disclosure of InterestsDavid Martínez-López: None declared, Joy Osorio-Chavez: None declared, Virginia Portilla: None declared, Carmen Álvarez-Reguera: None declared, Alba Herrero-Morant: None declared, Lara Sanchez-Bilbao: None declared, Iñigo Gonzalez-Mazon: None declared, Miguel A González-Gay Speakers bureau: Consultation fees/participation in company-sponsored speaker´s bureau from Abbvie, Pfizer, Roche, and MSD, Grant/research support from: Dr. Miguel A. Gonzalez-Gay received grants/research supports from Abbvie, MSD, and Roche, Ricardo Blanco Speakers bureau: Consultation fees/participation in company-sponsored speaker´s bureau from Abbvie, Lilly, Pfizer, Roche, Bristol-Myers, Janssen, and MSD., Grant/research support from: Dr. Ricardo Blanco received grants/research supports from Abbvie, MSD, and Roche

BackgroundIgG4-related disease (IgG4-RD) is an inflammatory and fibrosing entity with very heterogeneous clinical manifestations. Its pathogenesis remains unknown, clinical features are heterogeneous and unspecific, and recently released classification criteria are invaluable in early recognition of the disease. Therefore, regrettably IgG4 related disease continues underdiagnosed.Objectivesa) To evaluate the clinical characteristics of patients diagnosed with IgG4-RD in a single University hospital;b) To compare with other large series.MethodsStudy of patients from a referral hospital and literature review of cases diagnosed with IgG4-RD. Diagnosis was made accordingly to these criteria: a) Okazaki;b) Umehara;c) ACR/EULAR 2020; and/ord) clinical, laboratory and imaging suggestive findings(ref. 1-3). For the literature review, we searched PubMed and the Cochrane library from its inception until 31 December 2022, selecting the largest series.ResultsWe include 11 patients (7 females/4 males) (mean±SD age; 61.2±15.6 years) diagnosed with IgG4-RD. The organs affected at diagnosis were: aorta (n=5), pleura/lung (n=4), lymph nodes (n=3), salivary glands (n=2), retroperitoneum (n=2), lacrimal glands (n=1), bile duct (n=1), kidney (n=1), orbit (n=1), subglottis (n=1), pericardium (n=1), mesentery (n=1), maxillary sinuses (n=1). IgG4 values were increase in 2 (18%) patients (median [IQR]; 250.5 [201.0-300.1] mg/dL) (normal value <135 mg/dL). Blood plasmablasts were increased in 8 (73%) patients (median; 831 [785-1218] cells/mL) (normal values <653 cells/mL). In the literature review, 6 series of more than 100 patients each were selected. The main data from the different series are listed intable 1.Thefigureshows the most frequently affected organs in the different series. The pancreas was one of the most frequently involved. In contrast, in our series, aortic involvement followed by lung/pleura were the most frequent.ConclusionIgG4-RD is a very heterogeneous disease with involvement of virtually every organ of the anatomy, usually presenting with involvement of more than one organ. Despite the name of the entity, serum IgG4 is not always elevated.References[1]Okazaki K et al. Int J Rheumatol. 2012. PMID: 22690221[2]Umehara H, et al. Mod Rheumatol. 2012. PMID: 21881964[3]Wallace ZS et al. Arthritis Rheumatol. 2020. PMID: 31793250Table 1.Main features in series of more than 100 patients and in current seriesReferenceCasesSex Female (F)/ Male (M)Age, median [IQR] or mean±SDDiagnosis criteriaNumber of organs affectedLevel of serum IgG4 (mg/dL), median [IQR]Lanzillotta et al. Rheumatology 2020131F (n=36),M (n=95)62 [53-70]-Umehara: possible (46%), probable (2%), definitive (52%)-1 organ (26%)-More of 1 organ (74%)224 [115-382]An et al.Orphanet J Rare Dis 2022127F (n=35),M (n=92)63 [55-69]-Umehara: possible (82.6%), probable (2.3%), definitive (11.8%)-1 organ (20%)-2-4 organs (68%)-More of 5 organs (9%)980 [390-1520]Zongfei et al.Clin Rheumatol 2021102F (n=25),M (n=77)62 [54.1-65.8]-Okazaki (100%)Median [IQR]: 2 [1-3]399 [199-776]Wang et al.Arthritis Res Ther 2018215F (n=67),M (n=148)54 [46-62]-Umehara: possible (47.9%), probable (4.7%), definitive (47.4%)-1-2 organs (36%)-3-4 organs (47%)-5 or more organs (17%)896 [350-1860]Inoue et al.Medicine (Baltimore) 2015235F (n=189), M(n=46)67-Symptoms+laboratory +image/ Compatible histology (100%)-1 organ (41%)-2 or more organs (59%)470 [ND]Wallace et al.Arthritis Rheumatol 2015125F (n=49),M (n=76)50.3±14.9- Symptoms+laboratory +image/ Compatible histology (100%)-1 organ (38%)-2 organs (24%)-3 or more organs (38%)NDCurrent series11F (n=7),M (n=4)57 [54.5-73.5]-Okazaki: 45%-Umehara: possible (18%), probable (18%), definitive (9%)-ACR/EULAR 2020 (9%)-Symptoms+laboratory +image/ Compatible histology (54%)-1 organ (36%)-2 organs (27%)-3 or more organs (36%)66.3 [22.2-116.3]Figure 1.Involved organs in series of more than 100 patients and in current series (%)Acknowledgements:NIL.Disclosure of InterestsLara Sanchez-Bilbao: None declared, Javier Loricera Speakers bureau: Roche, Novartis, UCB Pharma, MSD, Celgene, and Grünenthal, Carmen Álvarez-Reguera: None declared, Alba Herrero-Morant: None declared, Ricardo Blanco Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Lilly, Janssen, and MSD, Grant/research support from: AbbVie, MSD, and Roche.

BackgroundUveitis is a frequent extraarticular manifestation of spondyloarthritis (SpAs). It has been classically reported that whereas uveitis in axial spondyloarthritis (ax-SpA) is predominantly anterior, unilateral, acute, and non-recurrent; in psoriatic arthritis (PsA) and in inflammatory bowel disease (IBD) it has been described as posterior, bilateral, insidious, and continuous [1,2].ObjectivesIn a large unselected series of SpAs, our aim was to assess the epidemiology and clinical features of SpAs-associated uveitis.MethodsStudy of consecutive patients from a single University Hospital with a) ax-SpA, b) PsA, and c) IBD (Crohn’s disease and Ulcerative colitis). We have selected patients with uveitis that were classified according to Standarization Uveitis Nomenclature (SUN) Working Group. Main general features, and uveitis pattern, location and onset were recorded.ResultsWe studied 2156 (1038 women/118 men) patients with SpAs: IBD (n= 1449; 67.2%); PsA (n= 406; 18.8%); and ax-SpA (n= 301; 14%).Uveitis was present in 87 (4%) (102 eyes) of 2156 patients with SpAs. However, uveitis occurs with varying frequency according to the SpAs subtype:14.6% of axSpA (n=44), 4.9% of PsA (n=20), and 1.6% of IBD (n=23) (Table 1).In the global SpAs, the most common pattern of uveitis was typically anterior (n=78; 89.7%), unilateral (n=72; 82.8%), acute (n=19; 82.6%), and non-recurrent (n=83; 95.4%).The comparative study between these three groups of SpAs showed a significant greater frequency of HLA-B27 positive, anterior location and acute onset in ax-SpA-related uveitis (Table 1).Table 1.Main clinical features and uveitis pattern.Ax-SpA (n=44)PsA (n=20)IBD (n=23)pMain general featuresAge, years, mean ±SD45.6 ± 10.343.1 ± 14.549.1 ± 14.60.472Sex, w/m, n, (% of women)25/19 (56.8)12/8 (60)17/6 (73.9)0.382Disease Duration, years, mean±SD18.6 ± 10.59.9 ± 8.217.4 ± 10.20.067HLA-B27 positive, n (%)37 (84.1)9 (45)5 (2.8)0.001*Uveitis locationAnterior, n (%)44 (100)16 (80)18 (78.3)0.006*Posterior, n (%)0 (0)0 (0)4 (17.4)-Panuveitis, n (%)0 (0)0 (0)1 (4.5)-Uveitis patternUnilateral, n (%)37 (84.1)16 (80)19 (82.6)0.922Uveitis onsetAcute, n (%)44 (100)20 (100)19 (82.6)0.003*ConclusionAlthough SpAs associated uveitis have different frequencies depending on the underlying disease, they share the same clinical pattern: anterior, unilateral, acute, and non-recurrent, in contrast with published data from selected series.References[1]Paiva ES, et al. Characterisation of uveitis in patients with psoriatic arthritis. Ann Rheum Dis. 2000; 59:67-70.[2]Lyons JL, Rosenbaum JT. Uveitis associated with inflammatory bowel disease compared with uveitis associated with spondyloarthropathy. Arch Ophthalmol. 1997;115:61-4.Disclosure of InterestsNone declared